High PMTCT Program Uptake and Coverage of Mothers, Their Partners, and Babies in Northern Uganda: Achievements and Lessons Learned Over 10 Years of Implementation (20022011)

Bannink-Mbazzi, Femke MA*; Lowicki-Zucca, Massimo MA*; Ojom, Lawrence MD*; Kabasomi, Sarah V. BA*; Esiru, Godfrey MD; Homsy, Jaco MD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: 15 April 2013 - Volume 62 - Issue 5 - p e138–e145
doi: 10.1097/QAI.0b013e318282d27f
Implementation and Operational Research: Epidemiology and Prevention

Background: The international nongovernmental organization “AVSI Foundation” has been actively supporting Uganda's Ministry of Health (MoH) prevention of mother-to-child HIV transmission (PMTCT) program since 2002 in 4 districts of the conflict-ridden Acholi subregion in Northern Uganda.

Objective: This article presents data covering 10 years of MoH/AVSI PMTCT program activities in Northern Uganda.

Methods: The program followed Uganda MoH PMTCT guidelines and aimed to be comprehensive, emphasizing social and medical care and support. Data were collected from 24 health facilities from January 2002 to December 2011. Trend analyses were carried out using Predictive Analytics SoftWare (PASW) Statistics 18.

Results: Of the 140,658 women who newly attended antenatal care services from 2002 to 2011, 94.4% received HIV testing and counseling and 6.2% tested HIV-positive. HIV testing and counseling of male partners of tested pregnant women steadily increased from 5.9% in 2002 to 75.8% in 2011, compared with 15.5% in 2011 nationally. Overall, 79.0% of HIV-positive women were started on antiretroviral prophylaxis (69.4%) or triple antiretroviral therapy (9.6%), compared with 52% nationally in 2011. The proportion of HIV-positive women who delivered in health facilities significantly increased from 55.8% in 2004 to 81.1% in 2011 (no national data available). HIV prevalence among HIV-exposed infants tested at or below 18 months of age significantly decreased from 10.3% in 2004 to 5.0% in 2011.

Conclusions: Our results show how a comprehensive PMTCT program emphasizing social and community engagement alongside medical care and support can succeed in a remote setting with multiple challenges.

*AVSI Uganda, Kampala, Uganda;

Ministry of Health, Kampala, Uganda;

University of California San Francisco, San Francisco, CA.

Correspondence to: Femke Bannink-Mbazzi, MA, AVSI Uganda, PO Box 6785, Kampala, Uganda (e-mail: femke.bannink@avsi.org).

Supported by the European Union, Dutch Government, the Elizabeth Glaser Pediatric AIDS Foundation, Italian and Spanish private foundations, USAID, and UNICEF.

The data included in this manuscript have not been presented at any public gathering. Preliminary data on AVSI 10 years of PMTCT program in Northern Uganda were presented at an organizational gathering in Campidoglio, Rome, on December 1, 2011.

The authors have no conflicts of interest to disclose.

F.B.-M. carried out the data analysis, and drafted the manuscript. M.L.-Z. carried out the statistical analysis and contributed to the drafting of the manuscript. L.O. supervised data collection, coordinated program activities, and contributed technical inputs for drafting the manuscript. S.V.K. participated in the study design and data collection, entry, and cleaning. G.E. provided technical inputs for drafting the manuscript. J.H. helped conceive the article, guided data analysis and presentation, and oversaw the general writing of the manuscript. All authors read and approved the final manuscript.

F.B.-M. is a Senior Program Advisor for AVSI Foundation's health, HIV/AIDS, and disability programs in Uganda. She has two master degrees in Psychology and Cultural Anthropology, and is a PhD candidate. M.L.-Z. works with AVSI Foundation and was involved in starting and supporting AVSI's PTMCT program in Kitgum and Pader districts between 2001 and 2003. He is currently based in AVSI Kampala and works as Program Manager. He has a master degree in Development Studies. L.O. is the Medical Superintendent of St Joseph's Hospital, Kitgum District, Northern Uganda, and has been involved in the AVSI PMTCT program since its onset. S.V.K. has been AVSI's PMTCT Programme Manager based in Kitgum, Northern Uganda from 2009 to 2012. G.E. is the National PMTCT Programme Coordinator at the Ugandan Ministry of Health in Kampala, Uganda. J.H. is Assistant Professor with the Global Health Sciences Program of the Department of Epidemiology and Biostatistics at the University of California San Francisco, CA. He is also an on-site investigator with the Makerere University—Johns Hopkins University (MU-JHU) Care Organization in Kampala, Uganda.

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Received July 27, 2012

Accepted December 10, 2012

© 2013 Lippincott Williams & Wilkins, Inc.